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2PACES COPY y6 > Prescribing > Flashcards

Prescribing Flashcards

1
Q

What dose of statin is used for primary and secondary prevention of cardiovascular disease?

A

Primary: 20 mg atorvastatin
Secondary: 80 mg atorvastatin

NOTE: rosuvastatin is a potent statin that is more likely to cause statin-induced myopathy

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2
Q

What dose of oral metronidazole is used to treat C. difficile infection?

A

400 mg every 8 hours for 10-14 days
Alternative: 500 mg every 8 hours

IMPORTANT: oral vancomycin should be used if it is a second episode of C. difficile colitis

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3
Q

What dose of omeprazole is used for peptic ulcers, gastro-oesophageal reflux and the prevention of ulcers?

A

Omeprazole 20 mg OD (usually for 4-8 weeks)

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4
Q

What is the first-line treatment option for cellulitis?

A

Oral flucloxacillin 0.5-1g QDS for 5-7 days then review

2nd line: oral clarithromycin 250 mg BD for 7–14 days (up to 500 mg BD for severe infections)

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5
Q

Which dose of cyclizine is used in nauseated patients?

A

Cyclizine 50 mg 8-hourly IM/IV/oral

WARNING: can cause fluid retention so avoid in heart failure

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6
Q

What is the maximum dose of PRN paracetamol?

A

Paracetamol 1 g every 6 hours (maximum 4 g/day)

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7
Q

Which PRN pain relief should be given for patients with mild pain?

A

Codeine 30 mg up to 6-hourly

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8
Q

Which regular medication should be prescribed for patients with severe pain?

A

Co-codamol 30/500, 2 tablets every 6-hours

WARNING: pay attention to how much paracetamol a patient is taking if they are taking PRN co-codamol and regular paracetamol

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9
Q

Which PRN medication should be prescribed for severe pain?

A

Morphine sulphate 10 mg up to 6-hourly

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10
Q

Which medications are used first-line in neuropathic pain?

A

Amitriptyline 10 mg oral nightly

Pregabalin 75 mg oral 12-hourly

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11
Q

What dose of ibuprofen should be used for pain?

A

Ibuprofen 400 mg 8-hourly

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12
Q

What is the dividing factor for dosing when switching patients from oral codeine to oral morphine?

A

Divide by 10

Same with oral tramadol to oral morphine

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13
Q

For patients with advanced and progressive disease who are in pain, what should be prescribed provided there are no comorbidities?

A

20-30 mg modified-release oral morphine (or immediate-release based on patient preference) - e.g. 15 mg BD
With 5 mg immediate-release oral morphine for breakthrough pain

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14
Q

If a patient on 30 mg morphine sulphate BD is switched onto a syringe driver, what dose of subcutaneous morphine should be given?

A

30 mg in 24 hours

NOTE: if changing to SC morphine from oral morphine, the dose should be divided by 2 or 3
NOTE: if changing to SC diamorphine, it should be divided by 3

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15
Q

What should be coprescribed in patients who develop pneumonia after influenza?

A

Flucloxacillin (cover S. aureus)

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16
Q

What does 1% mean with regards to weight/volume calculations? (e.g. 1% lidocaine)

A

1 g in 100 mL (i.e. 10 mg in 1 mL)

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17
Q

What does PReSCRIBER stand for?

A

Patient details (name, DOB and hospital number)

Reaction (e.g. allergy)

Sign the front of the chart

Contraindications to each drug

Route

IV fluids necessary?

Blood clotting prophylaxis necessary?

Anti-Emetic necessary?

Relief from pain?

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18
Q

What is the starting dose of ramipril and lisinopril in heart failure?

A

Ramipril: 1.25 mg OD

Lisinopril/Enalapril: 2.5 mg OD

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19
Q

When should ACE inhibitors be taken?

A

In the evening/night as it can cause postural hypotension

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20
Q

What dose of verapamil is used for rate control in atrial fibrillation?

A

40 mg 8-hourly

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21
Q

What is the usual daily starting dose of levothyroxine in hypothyroidism?

A

50-100 mcg

NOTE: in elderly patients and patients with comorbidities, a starting dose of 25 mcg OD may be used

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22
Q

What is the usual dose of amlodipine used for hypertension?

A

5 mg OD

Maximum of 10 mg OD

NOTE: it does not need to be taken at night

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23
Q

Which medications are usually taken at night?

A

Statins
Amitryptiline
ACEi

NOTE: atorvastatin can be taken at any time of the day

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24
Q

What is an appropriate starting regime of analgesia for palliative patients?

A

20-30 mg per day of modified-release morphine + 5 mg morphine for breakthrough pain

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25
Q

Outline the rules for converting doses of opioids.

A

Oral codeine –> oral morphine = divide by 10
Oral tramadol –> oral morphine = divide by 10
Oral morphine –> oral oxycodone = divide by 1.5-2
Oral morphine –> SC morphine = divide by 2
Oral morphine –> SC diamorphine = divide by 3

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26
Q

Which opioids are preferred in CKD?

A

Alfentanil, buprenorphine and fentanyl

NOTE: the same drug should be used for maintenance and break-through pain (e.g. fentanyl 50 mcg/actuation nasal spray in each nostril repeated after 10 mins if required)

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27
Q

Which analgesic should you prescribe to a patient with renal colic?

A

IM diclofenac 75 mg

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28
Q

How big should the breakthrough dose of morphine be?

A

1/6 of the daily dose

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29
Q

What is the starting dose of methotrexate for rheumatoid arthritis?

A

7.5 mg weekly
5 mg folic acid should be co-prescribed, to be taken more than 24 hours after the methotrexate dose

NOTE: methotrexate is available in 2.5 mg pills

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30
Q

List some p450 inducers.

A 
PC BRAS:
Phenytoin 
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic excess), 
Sulphonylureas
St John's Wort
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31
Q

List some p450 inhibitors.

A

AOI DEVICES

Allopurinol
Omeprazole
Imidazoles (ketoconazole, fluconazole)

Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides
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32
Q

What are some adverse drug reactions associated with gentamicin and vancomycin?

A

Nephrotoxicity

Ototoxicity

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33
Q

Which antibiotics are particularly notorious for causing C. difficile colitis?

A

Cephalosporins

Ciprofloxacin

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34
Q

List some adverse effects of ACE inhibitors.

A

Hypotension
Electrolyte abnormalities (hyperkalaemia)
AKI
Dry cough

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35
Q

List some adverse effects of beta-blockers.

A 
Hypotension 
Bradycardia 
Wheeze in asthmatics 
Worsens acute heart failure (drops CO)
Worsen plaque psoriasis
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36
Q

List some adverse effects of CCBs.

A

Hypotension
Tachycardia
Peripheral oedema
Flushing

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37
Q

List some adverse effects of heparins.

A

Haemorrhage (especially if renal failure or < 50 kg)

Heparin-induced thrombocytopaenia

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38
Q

List some adverse effects of aspirin.

A

Haemorrhage
Peptic ulcers
Tinnitus

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39
Q

List some adverse effects of digoxin.

A

GI:
Nausea and vomiting
Diarrhoea

Visual:
Blurred vision
Xanthopsia (yellow-green visual perception)

Neurological:
Confusion
Drowsiness

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40
Q

List some adverse effects of amiodarone.

A

Interstitial lung disease
Thyroid disease
Grey skin
Corneal deposits

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41
Q

List some adverse effects of lithium.

A

Early - tremor
Intermediate - tiredness
Late - arrhythmias, seizures, coma, renal failure, diabetes insipidus

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42
Q

List some adverse effects of statins.

A

Myalgia - r/v if CK >5x upper limit of normal
Abdominal pain
Increased ALT/AST - r/v if transaminases >3x upper limit of normal
Rhabdomyolysis

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43
Q

List some common drugs that have a narrow therapeutic index.

A

Warfarin
Digoxin
Phenytoin
Theophylline

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44
Q

Which commonly used medications should be stopped before surgery?

A

Antiplatelets
Anticoagulants
COCP
Lithium (omit the day before surgery)

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45
Q

What is the usual daily dose of alendronic acid?

A

10 mg

NOTE: 70 mg can be given WEEKLY in patients with post-menopausal osteoporosis

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46
Q

List some commonly used classes of medication that cause indigestion.

A

NSAIDs
Steroids
Bisphosphonates

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47
Q

What is the usual treatment dose of enoxaparin?

A

1.5 mg/kg

NOTE: 40 mg is the prophylactic dose

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48
Q

Which medications can reduce renal excretion of lithium?

A

ACE inhibitors
Diuretics (particularly thiazides)
NSAIDs

NOTE: if diuretics must be used in a patient on lithium, use loop diuretics

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49
Q

What is the target range for TSH in a patient with hyperthyroidism?

A

0.5-5.0 microIU/L

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50
Q

When might you expect fluid input to be greater than fluid output in a patient?

A

Correction of dehydration

Renal failure

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51
Q

What are the daily maintenance requirements of fluid and potassium when NBM?

A

Fluid: 3 L (i.e. 1 L per 8 hours)
K+: 40-60 mmol
So, 1 L 0.9% saline/0.15% KCl over 8 hours

25–30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride
and
approximately 50–100 g/day of glucose to limit starvation
ketosis

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52
Q

Which type of fluid should be used for maintenance in adults who are NBM?

A

Provided biochemistry is normal, they should have:
1 L of 0.9% saline
2 L 5% dextrose
Every 24 hours with 40-60 mmol KCl per day

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53
Q

What is the first-line diabetic medication in patients with CKD?

A

Gliclazide (sulphonylurea)

Metformin cannot be used if GFR < 30 ml/min

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54
Q

What is the normal starting dose of amitryptyline?

A

10 mg

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55
Q

Which antibiotic commonly interacts with statins and how should you deal with it?

A

Clarithromycin
It is a CYP3A4 inhibitor and it increases the toxicity of statins.
So, statins should be stopped during the course of clarithromycin.

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56
Q

Which medication can give immediate relief for patients with dyspepsia?

A

Magnesium carbonate 10 mL TDS

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57
Q

What is a major contraindication for using lactulose?

A

Bloating

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58
Q

What are some major contraindications for using Senna?

A

Colitis and cramps

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59
Q

What is the main difference between the side-effects of codeine and tramadol?

A

Codeine - constipation
Tramadol - agitation/hallucinations

NOTE: both of them cause typical opioid side-effects (respiratory depression, reduced consciousness, pinpoint pupils)

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60
Q

What dose of codeine is typically used for the management of pain?

A

30 mg 6-hourly

NOTE: maximum daily dose is 240 mg

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61
Q

What is the best way of measuring the therapeutic effect of an aminophyline infusion?

A

Oxygen saturations will improve

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62
Q

What is the best way of measuring tacrolimus levels in transplant patients?

A

Trough level before the morning or evening dose (aim for 6-10 ng/mL)

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63
Q

What is the target pre-dose trough concentration for vancomycin?

A

10-15 mg/L

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64
Q

List some common side-effects of calcium channel blockers.

A

Neuro:
Dizziness
Drowsiness
Headache

Cardio:
Palpitations
Tachycardia

Gastro:
Abdominal pain
Nausea
Vomiting

Skin:
Flushing
peripheral oedema
Skin reactions

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65
Q

Outline the management of high INR in patients on warfarin.

A

MAJOR BLEEDING: Stop warfarin + IV 5 mg vit K + PCC (or FFP)
INR > 8.0 + minor bleeding: stop warfarin + IV 1-3 mg vit K + restart warfarin when INR < 5
INR > 8 + no bleeding: stop warfarin + 1-5 mg oral vit K + restart warfarin when INR < 5
INR 5-8 + minor bleeding: stop warfarin + IV 1-3 mg vit K + restart warfarin when INR < 5
INR 5-8 + no bleeding: withhold 1 or 2 doses of warfarin + reduce subsequent maintenance dose

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66
Q

When should diuretics be taken and why?

A

Any time except the evening because they will be up all night peeing

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67
Q

Which commonly used NSAID is NOT nephrotoxic?

A

Aspirin

NOTE: it also rarely worsens asthma

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68
Q

Which type of bladder stabilising drugs should be avoided in myasthenia gravis?

A

Anti-cholinergic (e.g. oxybutynin, solifenacin)

Use mirabegron/duloxetine instead

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69
Q

Which medication can be given as a one-off for acute anxiety?

A

2 mg diazepam PO

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70
Q

Which parameter is important to monitor in patients on digoxin?

A

Serum creatinine

It is mainly excreted renally, so patients with renal dysfunction are at risk of digoxin toxicity

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71
Q

Which parameter is important to check at baseline and monitor in patients receiving sodium valproate?

A

LFTs (ALT)

Valproate is associated with hepatotoxicity

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72
Q

What should you keep an eye on when giving a patient IV aminophylline?

A

ECG - it can precipitate cardiac arrhythmias

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73
Q

What should be checked to identify theophylline toxicity?

A

Serum theophylline level (18 hours after commencing treatment)
Target: 10-20 mg/L

NOTE: aminophylline is a stable mixture of combined theophylline and ethylenediamine

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74
Q

When does enoxaparin require dose-adjustment?

A

eGFR < 30 mL/min

Weight < 50 kg

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75
Q

Which commonly used diabetes drugs can cause hypoglycaemia?

A

Insulin
Sulphonylureas (e.g. gliclazide)
Thiazolidinediones (e.g. pioglitazone)

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76
Q

List some drugs that cause urinary retention?

A 
Opioids
Anticholinergics 
General anaesthetics,
Alpha-adrenoceptor agonists,
Benzodiazepines (e.g. diazepam),
Non-steroidal anti-inflammatory drugs (e.g. ibuprofen),
Calcium-channel blockers,
Antihistamines,
Alcohol.
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77
Q

List drugs classes that can cause confusion.

A 
Opioids (e.g. morphine)
Metoclopramide 
Anticholinergics (e.g. oxybutynin, tiotropium)
Glucocorticoids (e.g. prednisolone)
Antibiotics (e.g. co-amoxiclav)
Diazepam 
Antipsychotics
Antidepressants
Anticonvulsants
Beta-blockers
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78
Q

How should the dosing of gentamicin be changed if the peak and trough concentrations are too high?

A

Peak too high –> reduce the dose
Trough too high –> increase interval between doses (giving more time for clearance)

Higher the dose, the higher the peak

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79
Q

Name two different LMWHs and their prophylactic and treatment doses.

A

Tinzaparin: 4500 U (prophylactic), 175 U/kg (treatment)
Enoxaparin: 40 mg (prophylactic), 1.5 mg/kg (treatment)

NOTE: enoxaparin 40 mg = 4000 U

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80
Q

List some drugs that contribute to hyperkalaemia.

A 
ACE inhibitors/ARB
Heparins (inhibit aldosterone synthesis) 
Tacrolimus 
Spironolactone/amiloride 
NSAIDs
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81
Q

When should aspirin be stopped before surgery?

A

7 days

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82
Q

How should patients on warfarin be advised ahead of elective surgery?

A

Stop warfarin 5 days before surgery

If INR > 1.5 on the day before surgery, give 1-5 mg vitamin K PO

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83
Q

Which monitoring parameter may rise slightly in patients started on ACE inhibitors?

A

Creatinine - but a rise < 20% is no cause for concern and treatment should continue (repeat U&E after 1 week)

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84
Q

What is the best gauge of whether chronic heart failure treatment (i.e. ACE inhibitors, beta-blockers) are working?

A

Exercise tolerance

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85
Q

How should the usual dose of insulin in a type 1 diabetic be changed if their blood glucose is being deranged due to the use of steroids?

A

Increase insulin dose by 10%

86
Q

When should patients be reviewed after starting a statin?

A

Measure total cholesterol, LDL and HDL 3 months after starting treatment
Aim for > 40% reduction in non-HDL cholesterol
If failed to achieved –> discuss adherence, consider increasing dose

87
Q

What medication should you prescribe for a mild CAP?

A

Amoxicillin 500 mg TDS for 5 days

Penicillin allergy: clarithromycin 500 mg BD for 5 days

88
Q

What medication should you prescribe for a HAP?

A

Piperacillin with tazobactam (aka tazocin) 4.5 g TDS IV

89
Q

How should acute dystonic reactions be treated?

A

Procyclidine

90
Q

Which steroid should be given to patients with an acute exacerbation of COPD?

A

30 mg prednisolone OD for 5 days

91
Q

Describe the interaction between warfarin and clarithromycin.

A

Clarithromycin increases the effect of warfarin (thereby leading to a rise in INR)

92
Q

How should patients be advised after missing one pill?

A

Take the missed pill and continue as per usual

They will be protected anywhere in the cycle

93
Q

Which diabetes drug used to lower lipids does simvastatin interact with leading to myotoxicity?

A

Gemfibrozil

94
Q

What should be checked and corrected before starting amiodarone?

A

Serum potassium

Because amiodarone can cause hypokalaemia

95
Q

How is phenytoin monitored?

A

Trough level

Therapeutic at 10-20 mg/L

96
Q

What are the main risks of using metoclopramide?

A

Cardiac conduction disorders as it causes QTc prolongation (e.g. electrolyte disturbances)
Extra-pyramidal side-effects (avoid if already on an antipsychotic)

97
Q

What dose of aciclovir should be used to treat shingles in adults?

A

800 mg 5 times daily for 7 days

98
Q

List some common drugs that can cause ankle oedema.

A

CCBs (e.g. amlodipine)

Naproxen

99
Q

What should you do with a patient’s normal long- and short-acting insulin regimes when you start treating them for DKA?

A

Stop short-acting
Continue long-acting
Place on fixed-rate insulin infusion

100
Q

How should you advise patients to take loperamide?

A

4 mg followed by 2 mg after each loose stool up to a maximum of 16 mg/24 h

101
Q

What monitoring is required in patients taking ciclosporin?

A

Liver and kidney function

NOTE: it is not myelotoxic

102
Q

Which opioid is safe to use in mild to moderate renal impairment?

A

Oxycodone - it is mainly metabolised by the liver

103
Q

In a patient with DKA, what range of serum K+ warrants giving fluids with KCl?

A

3.5-5.5 mmol/l - use 0.9% saline + 40 mmol/L of potassium replacement

104
Q

Name a commonly used NSAID that can cause hepatitis.

A

Diclofenac

105
Q

What is the maximum rate at which fluids containing potassium can be given through a peripheral cannula?

A

10 mmol/hour

NOTE: rates above 20 mmol/hour needs cardiac monitoring

106
Q

How many mmol of KCl are in 1 L of 0.3% potassium?

A

40 mmol

107
Q

How should long-term prednisolone dose be changed in patients who are acutely unwell?

A

Double it

108
Q

What is the dose of nebulised adrenaline that should be given in severe croup?

A

400 micrograms/kg

109
Q

Why shouldn’t diltiazem and verapamil be used in heart failure?

A

Worsens fluid retention

NOTE: if AF in heart failure, digoxin should be used

110
Q

Which anti-epileptic is safest to use in pregnancy?

A

Lamotrigine

111
Q

Which are the best anti-epileptics for focal epilepsy?

A

Lamotrigine

Carbamazepine

112
Q

In which patients with newly diagnosed T2DM should you avoid using metformin?

A

Underweight (as it causes appetite suppression)
Creatinine > 150 umol/L (risk of lactic acidosis)

In these scenarios, use gliclazide instead

113
Q

What should be checked before starting treatment with atypical antipsychotic drugs?

A

Fasting blood glucose

114
Q

How do you manage a Parkinson’s disease patient who is nil by mouth?

A

Get an urgent SALT assessment
Consider inserting NG tube
Consider prescribing rotigotine patch

115
Q

Which medications can be used to reduce secretions in palliative care?

A

Glycopyrronium
Hyoscine

NOTE: these are usually SC injections

116
Q

List some medications that exacerbate heart failure.

A 
NSAIDs (fluid retention)
Glucocorticoids (fluid retention)
Verapamil and diltiazem (negative inotrope and fluid retention)
Pioglitazone (fluid retention)
Flecainide 
Cyclizine (fall in cardiac output)
117
Q

How do you convert from morphine to alfentanil and fetanyl?

A

Morphine –> Alfentanil (divide by 30)
Alfentanil –> Fentanyl (divide by 5)
Breakthrough fentanyl = 1/8th of daily dose

118
Q

Which medications should be stopped before surgery?

A 
Insulin 
Lithium 
Anticoagulants/antiplatelets
COCP/HRT
K+ sparing diuretics and ACE inhibitors 
Oral hypoglycaemics (metformin)
Perindopril and other ACE inhibitors
119
Q

Which commonly used drugs should be avoided in peripheral vascular disease?

A

Beta-blockers

ACE inhibitors

120
Q

Which medication can be used as an alternative to LMWH in patients with VTE and a phobia of needles?

A

Apixaban 10 mg BD for 7 days

121
Q

Which medication is used for agitation in palliative care?

A

Midazolam

NOTE: haloperidol should be used for patients with hallucinations

122
Q

Which types of seizures can be treated with sodium valproate?

A

Tonic
Generalised
Absence (also ethosuximide)
Myoclonic

TAGM

123
Q

Describe the equivalent doses between prednisolone and hydrocortisone.

A

5 mg prednisolone = 20 mg hydrocortisone

124
Q

What is the maximum dose of lidocaine that can be administered as local anaesthetic?

A

3 mg/kg without adrenaline

7 mg/kg with adrenaline

125
Q

In which patients should 5% dextrose be avoided?

A

Stroke - increased risk of cerebral oedema

Unless maintaining glucose at 5-15mmol/L

126
Q

Which courses of steroids require weaning?

A

More than 40 mg prednisolone daily for 1 week
More than 3 weeks treatment
Repeated courses

127
Q

Which antibiotic is usually used for surgical prophylaxis?

A

Ceftriaxone 2 g IV stat

128
Q

How should a patient be switched from an insulin infusion to SC insulin?

A

VRIII should be stopped at breakfast or evening meal only (not at midday meal)
Administer usual dose of mixed insulin.
Allow patient to eat meal as normal.
Stop intravenous insulin infusion 30 minutes later.

129
Q

Common side effect of furosemide

A

Dizziness from dehydration

130
Q

Which vaccinations are recommended in pregnant patients?

A

Pregnant women are advised to have a whooping cough vaccination and a flu vaccination during pregnancy

131
Q

Low TSH
Normal T4 levels

For a patient treated on levothyroxine

A

Reduce the dose of levothyroxine by 25mg as the TSH is being suppressed

132
Q

Which Abx for UTIs is safe to use throughout pregnancy?

A

Cefalexin 500mg PO twice daily for 7 days

133
Q

Which drugs are classed as weak opioids?

A

Codeine, Dihydrocodeine or Tramadol

134
Q

In AKI which T2DM drug should be stopped?

A

Metformin

135
Q

Advice on taking bisphosphonates

A

Swallowed whole with water while sitting or standing.
On an empty stomach at least 30 minutes before breakfast (or another oral medicine)
Should stand or sit upright for at least 30 minutes after
tablet

136
Q

How often should a patient be monitored if they are taking prednisolone?

A

Patients should be reviewed regularly, every 3 months or within one week of a change in dose
of prednisolone

137
Q

Before administering adenosine what should you warn patients

A

They will experience chest discomfort and a sensation that people describe as ‘feeling like they are about to die’

138
Q

What would you prescribe for oral candidiasis?

A

Miconazole oral gel

139
Q

What drugs commonly cause dyslipidemia?

A

Thiazide diuretics are well-recognised causes of dyslipidaemia. Thiazides inhibit lipoprotein
lipase in capillaries which leads to an increase in the circulating concentration of VLDL and other
triglyceride-rich circulating lipoproteins.

140
Q

A patient develops a dry cough on ACEi, what should they start as a replacement?

A

ARB

141
Q

Why should patients starting metronidazole avoid alcohol?

A

Patients taking metronidazole may experience a disulfiram-like reaction when they drink alcohol.

142
Q

Mx of urticaria

A

Cetirizine Hydrochloride 10 mg oral once a day

143
Q

Mx of Scabies

A

Permethrin 5% Cream 1 application topical STAT

144
Q

What drug when prescribed with sertraline increases your risk of serotonin syndrome?

A

Sumatriptan

145
Q

How often should a young T1DM patient check their blood glucose?

A

Children and young people with diabetes should be advised to self-monitor their blood glucose,
by performing at least five capillary blood glucose tests per day. Note that more frequent testing
may be needed during periods of physical activity and during intercurrent illnesses.

146
Q

Which class of diabetic medications can increase your risk of UTIs?

A

Gliflozins (e.g. dapagliflozin) increase your chances of developing a UTI as they lower blood
sugar by increasing excretion of glucose in the urine. The high levels of urinary glucose which
acts as a good medium for bacterial growth, increasing the risk of UTI

147
Q

Two common side effects of tamoxifen

A

VTEs

Hot flushes

148
Q

Drugs that worsen psoriasis

A

trauma
alcohol
drugs: beta-blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids

149
Q

Monitoring requirements for Leflunomide

A

FBC and LFTs every 2 weeks

150
Q

Management of Impetigo

A

1st line: topical Fusidic Acid

2nd line: oral flucloxacillin

151
Q

Common side effects of Prednisolone

A

Fluid retention
Abdo pain
Indigestion

152
Q

Monitoring requirements starting methotrexate

A

Monitor:

FBC, U&Es and LFTs every 1–2 weeks until therapy stabilised

Thereafter patients should be monitored every 2–3 months.

153
Q

Anti tussive used in palliative care

A

chlorpromazine or haloperidol

154
Q

Which anticoagulant causes hyperkalaemia?

A

Heparins (e.g. dalteparin)

155
Q

When should you avoid nitrofurantoin?

A

eGFR < 45

156
Q

INR > 1.5 the day before a surgery. Mx?

A

Phytomenadione (Vit K) 2mg PO

157
Q

How would you manage a transient rise in blood glucose in a diabetic caused by corticosteroids?

A

An increase in the dose of insulin by 10% rather than adding another type of insulin such as act rapid

158
Q

The expected decrease in non HDL cholesterol when treated with an adequate dose of statins

A

After three months >40% decrease

159
Q

When should you test gentamicin levels?

A

6-14 hours after the first dose

These are the values on the X axis of the chart

160
Q

How can you calculate how a unit of insulin would affect a patients blood glucose?

A

100/ daily insulin intake = number of mmol per unit of insulin

161
Q

Target blood glucose for a patient going into surgery

A

Usually 6-10

162
Q

Which drugs are contraindicated in patients with PVD?

A

Beta - adrenoreceptor blockers (atenolol)

ACEi (cautioned)

163
Q

Drugs that increase the risk of thrush

A

Antibiotics

Systemic steroids

164
Q

How long should you treat scarlet fever for and what drug?

A

Phenoxymethylpenicillin 125mg PO 6 hrly

10 days

165
Q

Target INR for a mechanical heart valve?

A

3-4

166
Q

How can you find information about morphine to fentanyl conversions

A

Prescribing in palliative care section

167
Q

Analgesia for a patient currently in labour

A

Nitrous oxide

168
Q

Treatment for hyperphosphataemia

A

Calcium carbonate

169
Q

Chlamydia treatment in pregnancy

A

Erythromycin

170
Q

What urine output should make you suspect the polyuric phase of recovery from aki?

A

Urine output >200mL/h

171
Q

What needs to be monitored at baseline and thereafter with olanzapine?

A

Baseline lipids, then every 3 months, then annual

ECG to establish QTc one week after starting

172
Q

Sick day rules for steroids?

A

Double them

173
Q

How to prescribe laxatives like senna?

A

As 2 tablets

Or sachets

174
Q

Which drugs should be prescribed by brand name?

A

Modified release calcium channel blockers

HRT

175
Q

Drugs safe to use during breastfeeding?

A

antibiotics: penicillins, cephalosporins, trimethoprim
endocrine: glucocorticoids (avoid high doses), levothyroxine*
epilepsy: sodium valproate, carbamazepine
asthma: salbutamol, theophyllines
psychiatric drugs: tricyclic antidepressants, antipsychotics**
hypertension: beta-blockers, hydralazine
anticoagulants: warfarin, heparin
digoxin

176
Q

Drugs not safe to use during breastfeeding?

A 
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
177
Q

Drugs which decrease serum potassium?

A

Thiazide diuretics
Loop diuretics
Acetazolamide

178
Q

Drugs which increase serum potassium?

A 
ACE inhibitors
Angiotensin-2 receptor blockers
Spironolactone
Potassium sparing diuretics (amiloride, triamterene)
Potassium supplements (Sando-K, Slow-K)
179
Q

What reaction can NAC cause and how does it occur?

A

anaphylactoid reaction (non-IgE mediated mast cell release)

180
Q

Symptoms of cholinergic toxicity?

A 
Salivation
Lacrimation
Urination
Diaphoresis
GI distress
Emesis
181
Q

Symptoms of anti-cholinergic toxicity?

A 
Hot as a hare
Dry as a bone
Blind as a bat
Red as a beet
Mad as a hatter
182
Q

Which medications are usually given weekly?

A

Bisphosphonates

Methotrexate

183
Q

Digoxin monitoring?

A

at least 6 hrs post-dose

184
Q

Which meds are likely to worsen seizure control?

A 
alcohol, cocaine, amphetamines
ciprofloxacin, levofloxacin
aminophylline, theophylline
bupropion
methylphenidate (used in ADHD)
mefenamic acid
185
Q

Drugs CI in asthma?

A

NSAIDs
beta-blockers
adenosine

186
Q

Which drugs should be used with caution in patients with ischaemic heart disease?

A

NSAIDs
oestrogens: e.g. combined oral contraceptive pill, hormone replacement therapy
varenicline

187
Q

When to transfuse in IDA?

A

Severely symptomatic

Hb <70 or <80 if ischaemic heart disease

188
Q

1st line medication for GAD?

A

SSRI

189
Q

What predisposes to digoxin toxicity?

A

Hypokalaemia

190
Q

What should be monitored during phenytoin loading?

A

ECG - arrhythmias

191
Q

What electrolyte imbalance do thiazides cause?

A

Hyponatraemia
Hypokalaemia
Hypercalcaemia

192
Q

Which medications can reduce hypoglycaemic awareness?

A

Beta-blockers

193
Q

How to reduce the dose if trough levels are too high for gentamicin?

A

Increase the interval between doses

194
Q

What is the correction factor with regards to insulin and how do you calculate it?

A

Correction factor = effect of 1 unit of insulin on BM
CF = 100/total daily insulin dose
Allows you to figure out how much extra rapid acting insulin to prescribe

195
Q

What needs replacing first in refeeding syndrome? What can you use?

A

Phosphate

Phosphate polyfusor

196
Q

How to prescribe frequency of oxygen?

A

Continuous

197
Q

How can you dose oxygen?

A

If non-rebreathe: flow rate in L/min

If venturi: percentage on the mask

198
Q

What should you do about contraception if someone is taking an enzyme inducer?

A

Change to a contraceptive method not affected by enzyme inducers during tx and for at least 4 weeks afterwards

199
Q

What percentage solution of KCl contains 40mmol of potassium?

A

0.3%

200
Q

Which abx for UTI can be co-prescribed with methotrexate?

A

Nitrofurantoin

201
Q

Scarlet fever tx?

A

Phenoxymethylpenicillin

202
Q

What to do if 1 COCP missed at any point in cycle?

A

take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
no additional contraceptive protection needed

203
Q

What to do if 2 COCP missed in week 1 (day 1-7)?

A

Take last pill (even if 2 on one day)

Emergency contraception if sex in pill free interval or week 1

204
Q

What to do if 2 COCP missed in week 2 (day 8-14)?

A

Take last pill (even if 2 on one day)

Don’t need emergency contraception

205
Q

What to do if 2 COCP missed in week 3 (day 15-21)?

A

Take last pill (even if 2 on one day)
Finish pills in current pack
Omit pill free break and start new pack next day

206
Q

Which method of emergency contraception makes the POP less effective for 5 days?

A

Levonelle

207
Q

What to do if 1 traditional POP (3 hours) or desogestrel POP (12 hours) missed?

A

Take missed pill
If more than one pill missed - just replace one missed pill
Use additional contraception for 48 hours
If sex during pill free interval needs emergency contraception

208
Q

Important complication to watch out for in patients on SSRIs prescribed a new medication?

A

Serotonin syndrome

e.g. addition of tramadol

209
Q

What BP would require HRT to be stopped?

A

160/95

210
Q

When should the effect of HRT be reviewed?

A

3 months after starting tx

2PACES COPY y6 (12 decks)

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